|Year : 2018 | Volume
| Issue : 2 | Page : 121-126
Patterns and knowledge of contraceptive methods use among women living in Jeddah, Saudi Arabia
Faisal Alhusain1, Fahad Alkaabba1, Nada Alhassan1, Shams Alotaibi1, Sarah Breakeit1, Emad Musaudi2, Ahmed Alhasan3
1 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
|Date of Web Publication||1-Oct-2018|
Dr. Faisal Alhusain
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh
Source of Support: None, Conflict of Interest: None
Objectives: Birth control or contraception has become a fundamental part of women's healthcare. Multiple studies have been conducted to determine women's knowledge of contraception. This study aimed to know the patterns of contraception use and to assess the knowledge of contraceptive methods among women living in Jeddah, Saudi Arabia. Methods: A cross-sectional previously validated survey was carried out between June and December 2016 among female Saudi citizens aged 18 years or older and living in Jeddah City, Saudi Arabia. In total, 979 female participants responded to the questionnaire. Results: The prevalence of contraceptive use among Saudi women living in Jeddah was 67.7%. Preventing pregnancy was the most frequent reason for using contraception (69.7%). Oral contraceptives were the most commonly used contraceptive type used (31.8%) followed by intrauterine devices (21%). Almost 16.4% used the withdrawal method, and the male condom method was used by 13.6%. Mood swings and depression were the most common side-effects encountered (34.6%). Furthermore, primary educated individuals reported significantly less contraceptive use compared to individuals who had a high level of education by 47% (odds ratio = 0.53, 95% confidence interval = 0.3–0.95). Age, years of marriage, and number of children were not shown to have any significant effects on contraception use among the participants. Conclusions: The study showed knowledge gaps in the use of different contraception methods. The most common contraceptive methods among Saudi women in Jeddah are pills and intrauterine device. Education played a big role to use the different type of contraception. Effective strategies should be implemented to raise awareness of the appropriate use of contraceptives and dispel misconceptions.
Keywords: Contraceptive, knowledge, methods, Saudi, women
|How to cite this article:|
Alhusain F, Alkaabba F, Alhassan N, Alotaibi S, Breakeit S, Musaudi E, Alhasan A. Patterns and knowledge of contraceptive methods use among women living in Jeddah, Saudi Arabia. Saudi J Health Sci 2018;7:121-6
|How to cite this URL:|
Alhusain F, Alkaabba F, Alhassan N, Alotaibi S, Breakeit S, Musaudi E, Alhasan A. Patterns and knowledge of contraceptive methods use among women living in Jeddah, Saudi Arabia. Saudi J Health Sci [serial online] 2018 [cited 2019 Jul 20];7:121-6. Available from: http://www.saudijhealthsci.org/text.asp?2018/7/2/121/242506
| Introduction|| |
Birth control or contraception has become a fundamental part of women's healthcare, by which unintended pregnancies are prevented, and family planning is achieved using effective and safe methods. Over the past few decades, a remarkable increase in the use of contraceptives in the developing countries has been associated with a reduced number of unintended pregnancies, and thus, a reduction in maternal mortality by approximately 40%. Along with the benefits to women, better perinatal outcomes and child survival are reflected by the regulation of interpregnancy intervals. Moreover, these agents have multiple noncontraceptive health benefits and therapeutic uses, such as treating polycystic ovarian syndrome, reducing the risk of certain gynecological malignancies, regulating the menstrual cycle, and decreasing the incidence of sexually transmitted diseases. In general, contraception is achieved through several mechanisms including mechanical, chemical, hormonal, surgical, and natural. In spite of the complications related to contraception use, specifically with the use of hormonal methods, health benefits are shown to outweigh the risks of their use.,,
Multiple studies have been conducted to determine women's knowledge of contraception. A cross-sectional study that was conducted in 2012 in St. Louis (USA) included 4144 women. The responses to the questionnaire showed that 45% of women overestimated the effect of certain contraceptive methods, such as depot medroxyprogesterone acetate, patches, the pill, and condoms. Another study investigated the contraceptive knowledge and beliefs of 60 men and women in rural Malawi. The data were collected from focus group discussions, and the results indicated that people were knowledgeable about modern contraceptive methods; however, they did not usually use these contraceptives for various reasons, including side effects, such as prolonged menstruation, male impotence, and genital sores. Moreover, the study showed a tendency of people to adopt traditional family planning methods regarding infertility issues. In Saudi Arabia, a cross-sectional study conducted at King Khalid University Hospital in 2015 assessed the knowledge of 242 married women regarding emergency contraception (EC). The responses to the questionnaire revealed that 6.2% of the participants had some knowledge of EC, while 73.3% of the participants had some negative attitudes toward it. The study suggested that health-care professionals were the least common source of information. The reasons that hindered women from using EC were the side effects and religious beliefs. In a recent study in Al-Madinah Al-Munawarah assessing the family planning knowledge of over 300 female teachers, only one-third or less of the participants answered of the questions about contraceptives correctly, which revealed the need for health centers to provide better health education regarding contraceptives.
Due to the limited knowledge about contraceptives, there is an urgent need to increase awareness of contraception use. Studies of the understanding of family planning and contraceptive use conducted in Saudi Arabia and the Middle East are sparse. Therefore, this study investigated the patterns of contraception use and knowledge of contraceptive methods among women living in Jeddah, Saudi Arabia.
| Methods|| |
This cross-sectional study was conducted in Jeddah, Saudi Arabia, a city with a current population of 4.076 million people according to the Saudi General Authority for Statistics, over a period of 6 months, from June to December 2016 using a convenience sampling method. A total of 12 public places were selected to interview the targeted participants, women between the age of 18–50 years old and with Saudi nationality. Participants who were available and met the above-mentioned inclusion criteria were asked to take the survey, while those who were unable to answer the questions or who refused to participate in the study were excluded from the study. The questionnaire was distributed among 1271 adult females through an in-person interview by the research team, and 979 responses were obtained, yielding a 77% response rate. A self-administered previously validated Arabic questionnaire was used in the study. The questionnaire contained 16 questions about sociodemographic status (age, level of education, marital status, and number of children), contraception use and practices, and the reason behind their use or not. In addition, information about the knowledge of side effects and those that were encountered was also collected. Finally, the questionnaire included questions about the sources of information that people used to educate themselves about contraceptive methods and possible side effects. The Statistical Package for the Social Sciences (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY, USA) was used for data management and analysis. Descriptive analyses were carried out by calculating the frequencies and percentages for the categorical variables. The prevalence was reported as a percentage with 95% confidence intervals (CIs). Univariate logistic regression analysis was conducted to investigate the factors affecting contraceptive use. P < 0.05 was considered to indicate statistical significance.
| Results|| |
Details of the demographic characteristics of the participants are shown in [Table 1]. A total of 979 female participants responded to the questionnaire. The study included a wide age range of participants; however, the largest age group (57.1%) was aged between 20 and 35 years, followed by the group aged between 36 and 50 years (38%). With respect to education level, 9.2% held a master's degree or above, 61.2% held a bachelor's degree, and 29.6% had a high school or below. Among the participants, 82.3% were married; of whom, 64.2% had more than two children, 16.3% had one child, and only 10.7% had no children. The prevalence of contraceptive use among Saudi women living in Jeddah was 67.7%. Of those, who used contraceptives, there was a variation in the length of use, with 22% having used contraception for less than a year, 32.7% for between 2 and 5 years, and only 13.1% reported the use of contraceptives for > 5 years. Among the participants, preventing pregnancy was the most frequent reason for using contraception (69.7%), while 20.1% reported using contraception for medical issues. Concern over side effects and complications was reported as the most frequent reason for not using contraception (10.8%). Other reasons for not using contraception included planning to get pregnant (4.8%), being unmarried (5.1%), and the need to know more about contraception (3.9%). Notably, only one participant reported not using contraception due to medical advice, and the religious believes were reported by 12 participants. The study showed that participants' choice of the method of contraception was most commonly based on the advice of medical practitioners (55.2%) followed by family or friends (23.5%). The methods of contraception used by participants in this study are shown in [Figure 1]. Oral contraceptives were the most common contraceptive type used by the participants (31.8%) followed by intrauterine devices (IUD) (21%). Almost 16.4% used the withdrawal method, and the male condom method was used by 13.6%. The calendar method and patches were used by approximately equal proportions of the participants (5.8% and 5.2%, respectively). Awareness of contraception methods reported by the participants is shown in [Figure 2]. The contraceptive pill was the most commonly known method reported by the women who participated in the study (77.7%), and only a small proportion reported no knowledge of this method (0.6%). Among the participants, 66.2% were aware of the IUD method whereas 0.4% were unaware. Only, a small proportion of the participants was aware of the sponge and spermicidal methods (4% and 7.9%, respectively), with a high proportion reporting no knowledge of these methods of contraception (70% and 65.2%, respectively). Details of the encountered and known contraceptive side effects are shown in [Figure 3]. The most commonly encountered side effects were mood swings and depression (34.6%), with 48.6% of participants aware of these as possible side effects. Other side effects encountered by the participants included weight gain (23.3%), metrorrhagia (10.5%), menorrhagia (10.2%), decreased libido (9.7%), and acne (6.3%). There was some level of knowledge regarding most side effects. Among the participants, 42.5% were aware of weight gain as a side effect, while fewer were aware of metrorrhagia (20.4%), menorrhagia (17.1%), and unplanned pregnancy (13.6%). The relationships between contraceptive use and the demographic characteristics of the participants are depicted in [Table 2]. Interestingly, individuals with high school degree or less reported significantly less contraceptive use (P = 0.03, odds ratio = 0.53, 95% CI = 0.3–0.95) compared to individuals who had a master degree or above. However, age, years of marriage, and number of children were not shown to have any significant effects on contraception use among the participants.
|Figure 2: Awareness of contraception methods reported by the participants|
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|Table 2: Univariate logistic regression analysis of factors related to contraceptive use among the participants|
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| Discussion|| |
The use of contraception has markedly increased in Saudi Arabia over the past few decades due to their positive effects in preventing unintended pregnancies and treating certain conditions. However, only a limited number of studies have been reported describing the knowledge and use of different methods of contraception. Knowledge of such issues can help health policymakers and physicians to understand the situation more clearly, and to respond to the information appropriately.
In this study, 67.7% of participants reported using various contraceptive methods for different periods. This can be explained by the fact that 82.3% of the participants were married, yet it also provides an opportunity to analyze and understand their contraception practices. In one aspect, this finding shows the high prevalence of the use of contraception among married women in Saudi Arabia, which is consistent with the few local studies that have been reported. For example, in one study of the use of contraception among women in Al-Taif, a city on the Western coast of Saudi Arabia, 68.7% of the participants reported using contraception. However, two studies conducted in Al-Qassim province, one of the 13 provinces in Saudi Arabia,, showed remarkably different results. One of these studies, which investigated contraceptive choices among 287 married women, revealed that 86.1% of the participants used contraception. The second study conducted in a sample of 225 married women at primary care centers demonstrated that only 44.4% of the participants used contraception. The inconsistency in these results can be explained by the sample sizes used, the exclusion of nulliparous females, and the location in which the study was conducted.
Due to the variations in cultural, educational, or even religious backgrounds, reasons for using or not using contraception may vary significantly from one society to the other. Consequently, by assessing the reasons that lead women to decide whether or not to use contraception and the factors that play a role in their choice of the method, we can identify appropriate interventions and actions that are necessary. As is the case globally, the results of the present study showed that the most common reason for using contraception is preventing pregnancy. Regarding the basis on which females choose to use contraception, we found 2 main factors: advice from medical practitioners or family and friends, with a large proportion of the participants in this study depending on the latter source, which tends to be less reliable than medical advice. This fact can be attributed as one of the main factors for the low levels of knowledge regarding contraceptive methods and the spread of common misconceptions. This finding is consistent with multiple local studies,, and has been well reported in the literature, thus highlighted the necessity for increased public awareness. On a different level, the study revealed some notable reasons for not using contraception. For example, not using contraception based on the medical advice was reported only by one individual. This result shows that although medical advice is the most reported source of information used by women who choose to use contraception, this is not true among the women who choose not to adopt this practice. Fear of side effects or complications was the most reported reason for not using contraception and the spread of misinformation about contraception can play a significant role in this. The Saudi society is a religious society in which Islam, the main religion of the country, has a major influence on many aspects of the lives of its citizens. As such, a notable effect of religion on the use of contraception by women was expected. Although only a few of the participants reported that being Haram, or not allowed in Islam, was the reason for not using contraception, it was not one of the major reasons. This finding is inconsistent with local data, showing that religion is one of the main reasons for not using contraception. One possibility for this inconsistency is the variations in the degree of religiosity and social culture from one area to another in different Saudi provinces.
Identifying the most common types of contraception used among by women is very important because this information be used by physicians determine appropriate approaches to educating women in the use of contraception, and which side effects can be expected. Participants in this study reported oral contraceptives as the most commonly used method. This finding is consistent with most of the local studies addressing the same matter.,,, This consistent finding, along with the low level of awareness and knowledge contraception,, highlights the need for increased awareness, and the provision of education by physicians on the use of an appropriate method as well as the possible side effects and contraindications about which contraceptive users should be made familiar. However, our study investigated more details of other available methods of contraception and focused on the participants' awareness of these methods. This information can help physicians to advise women about different options for contraception about which they might otherwise be unaware. This issue has been noted globally, as in the International Contraceptive Knowledge and Awareness Study, which was conducted among 7000 women and revealed the failure of the participants to get beyond the pills without the use of new contraceptive methods.
The assessment of both the awareness and actual incidence of side effects is important, as it points to the potential for gaps women to experience side effects of which they have no knowledge. Furthermore, it provides physicians with a knowledge of the most commonly reported side effects. Our results showed that there was no disparity between the most commonly reported side effects (mood swings and weight gain) and the participants' knowledge of these side effects. Moreover, while pregnancy was a well-known side effect among the participants, this event was reported by only 11. In contrast, the actual incidence of decreased libido was higher than that of the participants who were aware of this side effect. These discrepancies in the awareness and incidence of side effects can be addressed by physicians ensuring that users are aware of such uncommon side effects.
Few studies have been conducted addressing a topic similar to that investigated in our study, which assessed the knowledge of contraception use in Saudi women and was conducted to fill the knowledge gap. First, the present study included a large sample (n = 979), which was sampled from multiple sites, while many local studies addressing this issue obtained the data only from health centers and with smaller sample sizes. Second, unmarried and nulliparous females were included in our study, which gives an insight into contraception use among this social group that was excluded from previous studies. Third, this study has assessed the side effects encountered and the knowledge of such side effects among users in Saudi Arabia, which has not been assessed previously. As with most studies, ours has some limitations including the investigation of women in a single city, Jeddah, which limits the generalization of the results. In addition, a convenience sample is the limitation in generalization and inference making about the entire population, which nictitate furthermore larger controlled studies to identify the use of contraception among Saudi females.
| Conclusions|| |
The present study demonstrated the patterns of contraceptive use methods among women in Jeddah, Saudi Arabia. The study showed knowledge gaps in the use of different methods with contraceptive pills are being in the top methods among Saudi women, followed by the IUD. Appropriate strategies should be implemented to raise awareness of the use of contraceptives and to dispel misconceptions. Moreover, this study provides the basis on which physicians can further target their actions toward educating contraceptive users. This can be accomplished by better communication between the physician and users, raising public awareness through campaigns, providing sources of information, and facilitating the process of obtaining such resources.
The authors would like to thank the publication office, King Abdullah International Medical Research Center, for their support and efforts in reviewing the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]